Making minor deities disappear in a puff of logic since 1972
Mon, 04 Aug 2008
Another Carson Update
Today we took Carson in to see a feeding specialist at Children's hospital to help us address the condition they diagnosed him with last week. Much less serious than laryngomalacia (which often requires surgical intervention to fix), Carson apparently suffers from gastroesophageal reflux or GERD (@wikipedia).
If you've heard of "acid reflux" on TV, it's basically the same thing, except in infants. Carson's symptoms are what appear to be painful feedings, particular breastfeeding which is typically done with the infant in horizontal orientation.
On Friday, we picked up a prescription for Zantac, a histamine blocker or "histamine-2 receptor antagonist" (@wikipedia) which prevents the release of gastric acid (for you chemistry geeks, that's HCl or hydrochloric acid-- pretty caustic stuff).
After a few doses, it seems to be making a difference, particularly with bottle feedings, which are easy to perform with Carson sitting upright (and with gravity's assistance to keep the acid where it needs to stay). Breastfeeding hasn't been any better, though, because that's typically performed with Carson in a horizontal (no gravity assist in keeping acids from reflux) orientation, which means he's still fussy when breastfeeding.
The purpose of today's visit was to get some tips for feeding, changing, and sleeping orientations for Carson to maintain the gravity-assisted prevention aspects of acid reflux. We now have some foam wedges to put on his changing table, to use during breastfeeding, and for his crib/basinette/moses bed replete with velcro straps to keep him inclined when he sleeps.
We hope that these wedges, plus the Zantac he's taking will help soothe his inflamed larynx, reduce the amount of acid (and hence the irritation) when he spits up (most babies do), and ultimately, reduce the fussiness of his breastfeedings which has confounded our ability to reduce not only bottle feeding, but the amount of formula as well. (It's a vicious circle-- fussiness when feeding horizontally at the breast means more bottle feeding is necessary. With less nursing at the breast, breast milk doesn't let down as much, or requires persistent pumping so we can avoid having to supplement with formula to meet his nutrition needs)
Today's session was great. No offense to the Overlake specialists, but the specialist at Children's gave us techniques that will not only help us help Carson, but help preserve our sanity as well... In a sentence, the difference of the approaches is "do two things at once" vs. "more pumpings/feedings!"...
Christine calculated the amount of time that "feedings" take. Here's a list of stuff we need to do at each feeding:
- Wake him up, every 2-3 hours (sometimes we let this go to 4-5 hours).
- Change his diaper, if it's required, and weigh him.
- Christine then breastfeeds for 20 minutes
- 15 minutes in, she dispatches me to warm up the refrigerated breastmilk from a previous pumping and/or formula
- We re-weigh to determine how much he nursed at the breast
- I feed him from one-two bottles for about 15 minutes to satiate him, meanwhile Christine begins pumping to store milk for a future feeding (he hasn't been taking enough at the breast due to his fussiness with GERD)
- Often I pause half way to burp him, otherwise we gets uncomfortable, or you allow the gas to be passed from the other opening-- less gas = happier baby, so add about 5 minutes of burping everytime he comes up for air.
- Then, I need to hold/comfort him for another 15 minutes in an inclined position to prevent reflux from irritating his throat.
- Then it's time to clean the bottles, run the dishwasher, refrigerate unused portions of formula, etc.
- Repeat every 2-3 hours.
So here's what's next: We're going to use the techniques we learned today (simultaneous feedings of pumped and breast feedings, using gravity assist techniques during sleep and feedings), and continue with the Zantac. If the situation markedly improves, we're in good shape. He should become less fussy, and we'll have broken the vicious circle I mentioned above.
If the situation doesn't improve, we're already scheduled next week for a "barium swallow test" (@wikipedia) which will help provide insight on the dynamics and severity of the reflux... How much comes back up, what's the physiology at play, etc. From there we'll get a sense of whether the Zantac is doing the trick, or whether we need to "escalate" to what are called "proton pump inhibitor" (@wikipedia) drugs (aka PPIs like Prilosec, Nexium, etc.).
In any case, it looks like by next Monday, we'll have enough insight to finally see the light at the end of the tunnel, unless the drugs/techniques we're putting in place this week will provide that clarity sooner.
A final thought on selecting the proper duration for paternity (or maternity) leave...
With feedings, diaper changes, travel time, appointments, research, shopping, burpings, etc. you can easily spend 10 hours a day caring for a newborn, with two people on the job.
Plus, it's taken us just 2.5 weeks to uncover, and begin to remediate the primary issues we've had with Carson. We've had a slew of pediatrician visits (a total of 4 so far), a follow up post-partum visit with a nurse, and a slew (4 so far) of lactation/feeding consultants, plus more appointments scheduled for next week.
Now, we fully realize that we have a very happy, healthy boy, who is just struggling with, let's face it, a relatively minor (in the scheme of all possible things) issue. Having said that, the severity doesn't reduce the effort we as parents are making to help relieve his symptoms and solve the underlying issues. Some parents may find an easier path, some might find a more arduous one, but you never know, particularly since you typically need to ask for paternity/maternity time in advance.
If the routine daily demands aren't substantial enough, you need several weeks to just get through the discovery, trial/error, and resolution phases, and having two parents around to handle the demands, for at least 3 weeks, will be key to handle a situation like ours. With every passing week, I'm more convinced that taking just short of five weeks was the proper thing to do.
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Blue Angels at Seafair 2008
On Sunday I took a couple hours to get out of the house and snap some pics of the Blue Angels from Mercer Island.
You can check out all of the pics by clicking on the image, which links to my photoset at Flickr.
Most pictures were taken with my 70-300mm 4-5.6IS/USM lens... However this outing really helped me see the shortcomings of the lens (warning: the remainder of this post consists of photo-geekery, safe to stop reading if this kind of stuff bores you :)...
Don't get me wrong, it is a quite excellent lens, particularly for the money. But here's where this lens, in my opinion, falls a bit short.
- The lens has a maximum aperture of f4 at 70mm, and 5.6 at 300mm. This means keeping the lens in manual mode requires you adjust the ISO or exposure constantly if you have to dynamically zoom in/out. As a result all of the pics were taken in auto mode, which means that on my XTI, no RAW images (for maximum flexibility in digital post-processing).
- The USM focus is really slow. If the autofocus happens to miss the object you're trying to focus on (like a fast flying jet), by the time it focuses close and goes back out far, the objective you're trying to shoot might be out of visual range.
- When you spend over $500 on a lens from Canon, they really should throw in the lens hood. Or, put another way, if you're buying a lens, and it doesn't come with a hood, you're either getting somewhat false economy (considering Canon's high end lenses come with them, price comparisons of cheaper lenses against an L series should include a hood to compare apples to apples)
- I didn't use a polarizing filter (I've yet to make a significant invest in any filters for my lenses) but I can see how it'd be frustrating to use one with this lens-- the front lens rotates as you zoom in/out, so adjusting the filter would be a pain during action photography.
I like the 70-300mm range that this lens provides as a "walk around" lens. Certainly the 70-300mm is no slouch for landscape or still photography, but for action shots, its no surprise that people opt for the faster L series lenses. I'm not frustrated enough that I'd consider replacing this lens with an L series lens (for one, most affordable lenses stop at 200mm, and I find the extra 100mm of zoom extremly useful)... but I might rent a lens for action photography in the future.
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